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DO11OS ENVIRONMENTAL INC. SAMPLING INFORMATION SHEET <br /> Client Delta Env Sampling Date <br /> Site 2537 Waterloo Rd (100966) Project No <br /> Stockton, CA Well Designation /14W-/6 <br /> Is setup of traffic control devices required? YES tune hours <br /> Is there standing water m the well box? Above TOC Below TOC <br /> Is top of casing cut level? NO SILlz If no,see remarks <br /> Is well cap sealed and locked? NO If no,see remarks <br /> Height of well casing riser(in niches) __ 14 <br /> Well cover type 8"or 12"W 12"EMCO 8"or 12"BK 8"Chnsty <br /> 12"Christy8"M&D , )e 12"M&D 12"DWP <br /> 12"CNI 36"CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Goode Fair Poor <br /> Purging Equipment 2"disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4"PVC bailer ^-Centrifugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2" ^� 4" 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time 7z0 _ Time JJ2,itt Calculated purge •P-. <br /> Depth of well ,C JI qb Depth to water Actual purge �-,5 <br /> Depth to water _ s!`J,L4 5 <br /> Start purge 17A Sampling time ea <br /> Time Temperature E C pH Turbidity Volume <br /> 711 i <br /> !750 `L-,l► 'I/ <br /> -791 <br /> Sample appearance Lock . <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap Lock 7132 Allenhead <br /> 4"Locking Cap Lock-Dolphin 9116 Bolt. <br /> 6"Locking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature' <br />